Maternal complication prevention: evidence from a case-control study in southwest Nigeria.

Kayode O Osungbade,Olubunmi O Ayinde

doi:10.4102/phcfm.v6i1.656

Abstract

BackgroundThe importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes.AimThis study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention.SettingThe study was carried out in a postnatal ward in a secondary health facility.MethodsThis was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases) was done, and one booked pregnant woman (control) was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05.ResultsBooked women had a lower median length of labour (10 hours) compared to unbooked women (13 hours). More women in the booked control group (139; 35.1%) than in the unbooked case group (96; 23.6%) reported at least one type of morbidity during the index pregnancy (p = 0.0004). Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery.ConclusionStrengthening antenatal and secondary healthcare services as short- and medium-term measures might be cost-effective as a preventive strategy in complications of pregnancy, whilst socio-economic dimensions of health are accorded priority in the long term.

Highlights

Recent evidence has shown that not all components of antenatal care are useful in improving maternal and perinatal outcomes,[1,2] the role of antenatal care utilisation in achievement of the Millennium Development Goals cannot be under-estimated
Low or non-utilisation and declining quality of maternal health services are interwoven challenges which are working against efforts aimed at improving maternal health outcome in developing countries
Apart from quality of care other factors are responsible for low utilisation of the maternal health service, amongst which age, education and socio-economic status are prominent

Summary

Introduction

Recent evidence has shown that not all components of antenatal care are useful in improving maternal and perinatal outcomes,[1,2] the role of antenatal care utilisation in achievement of the Millennium Development Goals cannot be under-estimated. Previous studies consistently reported poor quality of maternal health services.[8,9,10] Poor quality of care is one of the most common reasons why women do not choose to use available maternal health services. One study found that perceived quality of service was the most important factor influencing choice of facility for obstetric care.[11] perceived lack of quality in antenatal care was associated with a late first antenatal visit in Kenya.[8] low or non-utilisation and declining quality of maternal health services are interwoven challenges which are working against efforts aimed at improving maternal health outcome in developing countries. Apart from quality of care other factors are responsible for low utilisation of the maternal health service, amongst which age, education and socio-economic status are prominent. The importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes

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